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Peritoneal carcinomatosis (PC) had been regarded as a terminal disease, characterized by a very poor survival and worth treating with palliative therapy. A new strategy combining maximal surgery (cytoreductive surgery, CRS) with maximal regional chemotherapy (hyperthermic intraperitoneal chemotherpy, HIPEC) has been proposed to treat PC, resulting in long-term survival rate s in selected patients. The objective of this systematic review (SR) is to determine whether the performance of CRS and HIPEC results in a survival advantage and morbidity and mortality associated with CRS and HIPEC in patients with PC from colorectal origin. The searches were conducted via electronic databases including MEDLINE, EMBASE, the Cochrane library, 8 Korean DB and retrieved 858 non-duplicate citations. Two review authors independently applied the extracted data and assessed study quality. In the present SR, 1 RCT, 5 cohort studies, and 16 case series studies were examined. The pooled estimate of postoperative mortality rates, overall morbidity rates, major morbidity rates were 3.5%, 46.5%, 31.6%, respectively. One randomized controlled trial was finished comparing systemic chemotherapy alone with CRS followed by HIPEC and systemic chemotherapy. This trial showed a positive result favoring the studied treatment. The median survival was 12.6 months in the standard therapy arm and 22.4 months in the experimental therapy arm (log-rank test, p=.032). The SR showed that CRS and HIPEC had a statistically significant survival benefit over control groups. We concluded that CRS and HIPEC is medical ly necessary intervention. However, there is still a need for more evidence, ideally in welldesigned randomized controlled trials.
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